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Amphetamine Class of synthetic drugs similar effect to adrenalin Class of synthetic drugs similar effect to adrenalin Act by releasing noradrenalin and dopamine and inhibiting reuptake. Act by releasing noradrenalin and dopamine and inhibiting reuptake. D and L forms (D twice as powerful as a central stimulant) D and L forms (D twice as powerful as a central stimulant)

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Synthesised in Germany in 1887 Synthesised in Germany in 1887 Nasal decongestants until 1930’s Nasal decongestants until 1930’s Medically tested on hospital workers in 30’s to create wellbeing and relieve fatigue Medically tested on hospital workers in 30’s to create wellbeing and relieve fatigue WW11 to combat fatigue WW11 to combat fatigue OTC in 50’s, POM in 60’s OTC in 50’s, POM in 60’s Second most commonly injected drug Second most commonly injected drug

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Tolerance To some but not all aspects To some but not all aspects To gain euphoric effect may need to escalate dose To gain euphoric effect may need to escalate dose Cardiovascular effects Cardiovascular effects Appetite suppression Appetite suppression Used therapeutically for narcolepsy and hyperkinetic disorders Used therapeutically for narcolepsy and hyperkinetic disorders

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Amphetamine psychosis 309 regular amphetamine users 309 regular amphetamine users 13% screened positive for psychosis 13% screened positive for psychosis 23% clinically significant symptoms of suspiciousness, unusual thought content or hallucinations in the past year 23% clinically significant symptoms of suspiciousness, unusual thought content or hallucinations in the past year Swift onset Swift onset Delusions and hallucinations may mimic bipolar or schizophrenia Delusions and hallucinations may mimic bipolar or schizophrenia Abates within days with restoration of sleep and cessation of amphetamines Abates within days with restoration of sleep and cessation of amphetamines

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Smoking Smoking Cocaine hydrochloride unsuitable for smoking (decomposes high temps) Cocaine hydrochloride unsuitable for smoking (decomposes high temps) Alkaloid can be freed from hydrochloride by using ether, vaporises easily Alkaloid can be freed from hydrochloride by using ether, vaporises easily

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Crack Cooking cocaine with baking powder and water Cooking cocaine with baking powder and water Baking powder precipitates impurities Baking powder precipitates impurities Pure crystalline cocaine Pure crystalline cocaine Usually smoked in pipe or sprinkled on cigarette Usually smoked in pipe or sprinkled on cigarette Sudden intense high Sudden intense high

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Reaches brain within seconds Reaches brain within seconds Euphoria abates quickly Euphoria abates quickly User feels restless and irritable User feels restless and irritable Marked craving Marked craving Use often escalates quickly to chase the high Use often escalates quickly to chase the high

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Treatment Not as well defined as for opiate addiction Not as well defined as for opiate addiction Psychosocial interventions using semi- structured interviews Psychosocial interventions using semi- structured interviews Acupuncture Acupuncture

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Ketamine Developed 1962 by Pfizer Developed 1962 by Pfizer Used as a general anaesthetic or in pain relief Used as a general anaesthetic or in pain relief NMDA (Glutamate) receptor antagonist NMDA (Glutamate) receptor antagonist Action particularly in the prefrontal cortex and hippocampus Action particularly in the prefrontal cortex and hippocampus At higher levels binds opioid receptors, partial D2 agonist and inhibits dopamine reuptake At higher levels binds opioid receptors, partial D2 agonist and inhibits dopamine reuptake